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Abstract: PO0799

Severe Hypernatremia as an Unintended Consequence of COVID-19-Related Social Distancing

Session Information

Category: Trainee Case Report

  • 000 Coronavirus (COVID-19)

Authors

  • Mohamed, Mahmoud Magdy, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Johnson, Stacy Alana, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Wall, Barry M., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Introduction

COVID-19 is primarily a respiratory infection which can have adverse effects on multiple organ systems. There is limited information concerning the harmful effects of social distancing in patients with chronic illnesses who avoid seeking medical attention due to fear of contracting the novel COVID-19 disease.

Case Description

A 64-year-old African American female with a past history of HIV- related dementia and seizure disorder was residing with family members, requiring assistance with activities of daily living. She was ambulatory but needed assistance with hygiene and meals. The family reported that over the past 7-10 days, she had become less interactive, remaining bedbound and resisting oral intake. There was an initial reluctance to bring her to the Medical Center due to the fear of contracting COVID-19 infection, given her immune-suppressed status. Despite family efforts to provide social distancing and home care, mental status progressively worsened, prompting presentation to the emergency department.
The patient had a GCS of 10. The patient was nonresponsive, did not follow commands, and only withdrew from noxious stimuli. Vital signs were prominent for fever 37.70 C and blood pressure was 94/64 mmHg. Pertinent laboratory results included: serum sodium, 201 mEq/L, plasma osmolality, 431 mOsm/kg, BUN 107 mg/dl, and creatinine of 4.8 mg/dL. CT head showed no acute intracranial pathology. Her condition required ICU care, including mechanical ventilation. COVID-19 screening was negative, while culture of lower respiratory secretions was positive for Staphylococcus aureus. With treatment of the respiratory infection and gradual hydration with 0.9 % sodium chloride solution which was shifted to Dextrose 5% after 3 days, the serum sodium concentration decreased to167 mEq/L. The patient was extubated and mental status gradually improved toward her baseline level. Serum sodium improved to 140 mEq/L and serum creatinine improved to 0.7 mg/dL over a 10 day period. The patient was subsequently transferred to a rehabilitation unit.

Discussion

Despite the pivotal role of social distancing in preventing the spread of the novel Coronavirus, reluctance in seeking medical attention can lead to serious and even life threatening consequences.